Extension of insurance to the family

The growth in coverage of wage earners as well as the initiation
of medical services to the beneficiaries made evident the need for coverage of
their dependents as well. The board of directors listened to the requests for
services, in particular those coming from the coffee plantations. Soon after the
Ley Constitutiva de la Caja was approved, almost all the social protection
organizations in the country explored the possibility of a closer relationship
with the Social Security Institute in order to obtain financial support for the
hospitals under their jurisdiction. Local interests, however, quickly stopped
the initiatives from these organizations. The exception was in Turrialba, where
distance and other factors had created a unique situation. The Municipal Council
obviously with external advice, established a system to cover the populations of
large farms. The system was funded through a wage tax (3% provided by the worker
and 2% by the employer), to provide health care to the farm workers and their
families. It included medicines, and financed the small local hospital. All this
was achieved in 1944. The community requested the transfer of the William Allen
Hospital in Turrialba and the inclusion of workers and their families for
maternity as well as medical care. The Institute now experienced a paradox,
since it now offered services beyond the Central Plateau and provided family
medical coverage in a rural area. Both events were an exception to the
traditional development followed by Social Security Institutions.

As a result of this precedent, the rural populations of the
Central Plateau began to request service for their families as well. In 1955 the
Board of Directors of the Council adopted the provision of medical services to
dependents as a permanent policy. An analysis of the coverage (Table l) shows
clearly thee the inclusion of family members resulted a rapid increase in the
number of persons covered. By 1960, five years later, although there had been
very little increase in the number of insured workers there were now an equal
number of ocher family members covered. The total increase reflected well the
coverage of the total population that increased from 12% to 15%.

FIGURE 1. Total Population,
Economically Active Population (PEA), Illness and Maternity Insurance (SEM), and
Old Age and Life Insurance (IVM) Costa Rica, 1950-1990